<%@ include file="/view/template/header.jsp"%>	
	<div id="content">
    	<%@ include file="/view/ehr/ehr_common.jsp"%>
        <div class="right-content">
			<div class="box">
				<s:if test='replyMessage.message!="empty"'>
					<s:property value="replyMessage.message"/>
				</s:if>
				<s:else>
					<h1><s:text name="label.admit.admission_information"/></h1>
					<s:form action="admit_patient_form">
						<div class="con-part">
							<span><s:label key="label.admit.patient_id"></s:label></span>
							<s:textfield key="admit.patient_id" value="%{#parameters['patient_id'][0]}" required="true" cssErrorClass="error" />
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.admiting_officer"></s:label></span>
							<s:textfield key="admit.admiting_officer" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.bed"></s:label></span>
							<s:textfield key="admit.bed" value="%{#parameters['bed_no'][0]}" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.ward"></s:label></span>
							<s:textfield key="admit.ward" value="%{#parameters['ward_no'][0]}" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.admit_reason"></s:label></span>
							<s:textfield key="admit.admit_reason" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.consultant_id"></s:label></span>
							<s:textfield key="admit.consultant_id" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.admission_date"></s:label></span>
							<s:textfield name="admit.admission_date" id="datetimepicker" class="input-text" cssErrorClass="error"></s:textfield>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.diagnosis"></s:label></span>
							<s:textfield key="admit.diagnosis" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.observation"></s:label></span>
							<s:textfield key="admit.observation" required="true" cssErrorClass="error"/>
						</div>
						<div class="clear"></div>
						<h1><s:text name="label.admit.guardian_information"/></h1>
						<br/>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.prefix"></s:label></span>
							<s:select key="admit.guardian.prefix" list="#{'Rev.': 'Rev.', 'Dr.': 'Dr.', 'Mr.': 'Mr.', 'Mrs.': 'Mrs.', 'Miss.': 'Miss.'}" headerKey="1" headerValue="---Select Prefix---" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.given_name"></s:label></span>
							<s:textfield key="admit.guardian.given_name" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.furthur_names"></s:label></span>
							<s:textfield key="admit.guardian.furthur_names" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.surname"></s:label></span>
							<s:textfield key="admit.guardian.surname" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.nic_no"></s:label></span>
							<s:textfield key="admit.guardian.nic_no" required="true"cssErrorClass="error"/>
						</div>
						<br/>
						<div class="clear"></div>
						<h1><s:text name="label.admit.guardian_contact_details_address"/></h1>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.addresses.house_number"></s:label></span>
							<s:textfield key="admit.guardian.addresses.house_number" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.addresses.street"></s:label></span>
							<s:textfield key="admit.guardian.addresses.street" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.addresses.city_1"></s:label></span>
							<s:textfield key="admit.guardian.addresses.city_1" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.addresses.city_2"></s:label></span>
							<s:textfield key="admit.guardian.addresses.city_2" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.addresses.country"></s:label></span>
							<s:textfield key="admit.guardian.addresses.country" required="true" cssErrorClass="error"/>
						</div>
						<br/>
						<div class="clear"></div>
						<h1><s:text name="label.admit.guardian_contact_details_other"/></h1>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.telephoneNumbers"></s:label></span>
							<s:textfield key="admit.guardian.telephoneNumbers" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.email"></s:label></span>
							<s:textfield key="admit.guardian.email" required="true" cssErrorClass="error"/>
						</div>
						<div class="con-part">
							<span><s:label key="label.admit.guardian.guardian_relationship"></s:label></span>
							<s:select key="admit.guardian.guardian_relationship" list="#{'Mother':'Mother', 'Father':'Father' , 'Sister':'Sister', 'Brother':'Brother', 'Grand Mother':'Grand Mother', 'Grand Father':'Grand Father', 'SPOUSE':'SPOUSE', 'Aunt':'Aunt', 'Uncle':'Uncle'}" headerKey="1" headerValue="---Select Relationship--"/>
						</div>
						<s:submit key="label.admit.submit" cssClass="green"/>
					</s:form>
				</s:else>
			</div>
		</div>
	</div>
	<script type="text/javascript" src="<% out.print(baseURL);%>/view/template/js/jquery-ui-timepicker-addon.js"></script>
	<script>
$(function() {
$("#tabs").tabs();
});
$(function() {
$('#datetimepicker').datetimepicker();
});
</script>
<%@ include file="/view/template/footer.jsp"%>
